Family presence during resuscitation encouraged

TORONTO - When a code blue is announced in hospital and a resuscitation team rushes to a patient's side, tradition has dictated that family members get out of the way, both to protect their sensibilities and to give doctors and nurses the room and concentration needed to perform life-saving care.

But that notion of separating patient and loved ones is slowly being replaced by a new model of care, in which family members are given the option — and sometimes even encouragement — to remain near the bedside, where their presence is viewed as beneficial.

Among centres embracing the idea is Calgary's recently opened acute-care hospital, South Health Campus, where staff make sure family members know they are welcome to be present during a resuscitation if they so choose.

When Lisa Lazenby's then two-month-old son Abel suddenly had a seizure and stopped breathing at home in February 2013, she and her husband rushed to the nearby hospital, where staff whisked the baby off to the ER's resuscitation room.

Supported by a family liaison worker — her husband Jason had taken their two older children to a friend's home — Lazenby initially stood in the corner, biting her nails and trying to stay out of the medical team's way so she wouldn't jeopardize the care of her son.

"Part of that is you're really scared of what's happening to him ... And you also get accustomed to thinking that the doctors want you out of the room and out of the way, because on TV shows it's always like that," she said Wednesday from Calgary.

She then heard a doctor working on Abel ask: "Where's Mom?"

"He said, 'You won't be in the way because you are the only voice and sound and touch that he will recognize in the whole room, so you come close and we will work around you,'" Lazenby recalls.

"I just went right in and I held onto his little head and his eyes were closed and he was quite unresponsive, but I was like petting his head and trying to sing to him a little bit.

"Then you get a front-row view — they're trying to get in an IV and they're trying to do all these things and I can just talk to him," she says. "That sticks with me forever because that room, of course, is buzzing with people and beeps and sounds, and if I imagine myself in his little shoes, of course the only sound that's familiar is me.

"I thought that was pretty impressive on the team's part and I won't ever forget it."

Joanne Ganton, manager of the Patient and Family Centred Care program at South Health Campus, said the idea of hospitals including loved ones during life-saving efforts raised a number of objections in the past, including that it would be too traumatic for families to witness, there would not be enough room to work and there was a danger of a person fainting, thereby creating another patient.

However, research into the issue and experience shows those fears haven't been borne out, said Ganton.

"All the families that attended said they would attend a code in a heartbeat."

Stephen Samis, vice-president of programs at the Canadian Foundation for Health Care Improvement, said studies have shown that the presence of family has a number of benefits — for the patient, their loved ones and the resuscitation team.

"What they've found is ... that families want to be there and they're not traumatized by the experience," Samis said from Vancouver, where he was attending the International Conference on Patient- and Family-Centered Care.

"In fact, they're less traumatized than if they've been waiting out in the corridors and having somebody come out and tell them, 'Well, here's what happened. Here's what the results were.'

"Their loved one will often understand and feel their presence and they also can see how hard the providers are working to try to do what they can for the patient," he said, adding that research suggests patient outcomes are better, care is improved and there are fewer medical errors.

"Having the loved ones of the patient present really creates a much better experience for everybody."

While resuscitation staff may experience some performance anxiety under the eyes of family members, Ganton said loved ones are typically focused on the patient.

"They just want to be close, because your biggest fear is 'I don't want him to die alone. I don't want him to die with strangers.'"

And if a patient doesn't survive, she said, family members often regret they weren't at the bedside: "They feel that if 'he could have just heard my voice, felt my touch, I know that he would have known I was there for him, and maybe he would have held on.'

"It's that regret. It's not knowing what happened," Ganton said, adding that witnessing a loved one's end can help ease the grieving process.

Fortunately for Lazenby, the team was able to stabilize her son, though he spent a week sedated and intubated in a children's hospital for a week until he fully recovered. Doctors said Abel, who'd been born seven weeks' prematurely, had been struck down by a cold virus and his tiny airwaves had swollen closed, leaving him unable to breathe.

Now 20 months old, he still has the odd episode of breathing difficulties but is otherwise healthy.

But at the time, as she watched the doctors and nurses frantically working on her boy, Lazenby was terrified of what might happen.

"It was really momentous for me because I think in that moment I thought if he does — it's awful, I can't even say it — if he does die, then I have to be here," she said, her voice breaking with emotion at the still-raw memory. "I can't have been out of the room and missed those moments.